The Health Insurance Claim Plain Language and Simplification Act mandates that health insurance carriers in New Jersey provide a clear and concise written explanation of benefits (EOB) form to covered individuals whenever a claim is processed. The EOB must include essential information such as the insured's name, healthcare provider's name, date of service, claim amount, amount paid by the carrier, and the amount owed by the covered person. Additionally, if a claim is partially or fully paid, the form must explain the reasons for the payment, and if denied, the reasons for denial must also be provided. The bill emphasizes that this information should be the only content on the first page of the EOB and must be presented in a 12-point font using simple, plain language.

The act aims to enhance transparency and understanding for covered individuals regarding their health benefits claims. It aligns with the principles set forth in the Life and Health Insurance Policy Language Simplification Act, ensuring that the language used is accessible and comprehensible. The provisions of this act will take effect 90 days after its enactment, promoting a more straightforward communication process between health insurance carriers and their clients.